197610174-8-13-2021-31-AS-MRUZ-C5UQGK-20210813120939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610174
Report Date: 08/13/2021
Date Signed: 08/13/2021 12:10:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	RIDGEVIEW HOME CARE CENTER		FACILITY NUMBER:	197610174
ADMINISTRATOR:	MANICDAO, MARY PRINCESS F.		FACILITY TYPE:	740
ADDRESS:	2327 RIDGEVIEW AVE		TELEPHONE:	(323) 308-8002
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY:	6	CENSUS: 4	DATE:	08/13/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Mary Manicdao - Administrator		TIME COMPLETED:	12:30 PM

NARRATIVE

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At 10:01 a.m., Licensing Program Analysts (LPA) Melissa Ruiz, Angela Panushkina and LaQueena Lacy conducted an announced Pre-Licensing visit to this facility and met with applicant Mary Manicdao. This is a change of ownership application from (LIC 197608809) to (LIC 197610174). The applicant is "Ridgeview Home Care Center". LPA conducted an entrance interview with the Administrator. At the time of this visit LPAs observed and assessed four (04) residents present in the facility. All residents appear to be clean and groomed. Fire Clearance dated 05/20/2021 was received for six (6) bedridden residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPAs touring the physical plant inside and outside and observed the following:

The facility has a total of six (6) bedrooms, five (5) of which are designated for resident use and one (1) bedroom is designated for staff use. Resident bedrooms were observed to be appropriately furnished. There are three and a half (3.5) bathrooms in the facility and all were observed to have non-skid mats and appropriate grab bars installed.

The common areas (living room, kitchen and dining areas) were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked cabinet near the entrance area. The fire extinguisher is located in the kitchen and was observed to be fully charged and was serviced on 05/24/2021. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 10:35 a.m. they were tested and observed to be operational. At 10:45 a.m. the hot water was tested in the common bathrooms and measured between 114.3-118.3°F. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted by the entrance wall with other posting requirements. Medications are stored in a locked cabinet in the kitchen area. The first aid kit is readily available.

(CONT. ON LIC 809-D)

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RIDGEVIEW HOME CARE CENTER	FACILITY NUMBER: 197610174
	VISIT DATE: 08/13/2021

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(CONT. FROM LIC 809)

Facility appears to be clean, in good repair and kept at a comfortable temperature of 78°F. Appliances in the kitchen appeared to be functional. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors.

There is a shaded sitting area in the backyard for residents to conduct outdoor activities. The backyard is fenced. The detached garage is located behind the house and is kept locked. The garage is currently being used as a laundry area, perishable and non-perishable food storage, PPE storage and staff office/break room. Component III was conducted with the administrator.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted with Licensee Representative Mary Manicdao and a copy of this report was provided.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa Ruiz	TELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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